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RC313.D37B56      Consumptives  in  Dela 


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( f 1 ^^ — 


CONSUMPTrOIS 
IN  DELAWARE 


By  JOHN  J.  BLACK.  M.  D. 

Member  of  the  College  of  Physicians,  Philadelphia 
Member  of  the  Delaware  State  Medical  Society,  Etc. 


.it 

1, 


A 


Published  for  the  Author. 
1902 


V 


3 


-RC 


l^^ 


pruface:. 


Delaware,  from  her  geographical  position,  from  the  intelli- 
gence of  her  citizens,  and  from  the  productiveness  of  her  soil,  has 
always  held  a  commanding' place  in  the  Union  of  States. 

To  hold  this  place  secure,  it  is  necessary  for  her  to  keep  step 
with  all  advancement,  both  of  material  and  thought.  To  assist  in 
furthering  this  end,  this  brochure  has  been  written. 

Ji\0.  J.  BLACK. 
New  Castle,  Delaware,  October,  1902. 


Consumptives  in  Delaware. 


Consumption  has  been  well  termed  the  Great  White  Plague, 
and  has  probably  been  coexistent  with  animal  life  on  the  earth! 
and  is  as  common,  if  not  more  common,  among  the  lower  animals 
than  it  is  among  human  beings.  It  has  been  noted  and  described 
by  Hippocrates  as  far  back  as  460  B.  C,  but  it  was  not  until  the 
year  1882  that  we  knew  surely  its  real  cause.     Then  it  was  tiiat 


^^LS 


Robert  Koch  gave  to  the  world  his  great  discovery  of  the  Bacillus 
Tuberculosis,  and  since  that  day  we  have  known  that  this  little 
microscopic  rod-shaped  body,  a  body  of  the  vegetable  kingdom, 
but  so  close  to  the  animal  kingdom  as  to  be  almost  of  it.  is  the 
active  cause  of  all  tuberculous  troubles,  in  fact,  is  tuberculosis  it- 
self, is  consumption  itself.  Probably  every  seventh  person  who 
dies,  dies  of  some  form  of  tuberculosis,  and  most  of  these  die  from 
tuberculosis  of  the  lungs,  which  we  commonly  call  consumption. 
Many  years  ago  the  geographies  told  us  that  forty-five  i)eople 


died  in  the  world  every  minute.  To-day  it  is  estimated  that  two 
people  die  of  tuberculosis  in  the  world  every  minute.  It  is  indeed 
the  Great  White  Plague,  and  yet  the  average  man  takes  little  or 
no  account  of  it.  Surely  there  is  an  awakening  going  on  and  the 
fight  against  these  parasitic  diseases  is  just  beginning,  and  in  one 
or  two  hundred  years  we  may  hope  to  see  them  in  a  great  measure 
banished  from  the  world,  provided  the  battle  is  properly  waged, 
and  the  weapons  in  our  hands  are  diligently  used.  Tuberculosis 
is  not  nearly  so  controllable  as  cholera,  yet  what  a  panic  cholera 
creates  when  it  attacks  a  community.  Tuberculosis  is  carrying 
off  millions  where  cholera  is  carrying  off  thousands,  yet  how  su- 
pine has  man  been  in  waging  war  upon  tuberculosis,  his  worst  of 
earthly  enemies. 

My  object  in  writing  this  brochure  is  tO'  bring  this  matter  of 
the  contest  againsit  consumption  before  the  people  of  Delaware, 
and  to  urge  that  they  be  not  laggards  in  this  fight,  which  in  the 
end  must  do  so  much  toward  the  upholding  and  even  the  preser- 
vation of  the  human  race.  In  the  treatment  of  her  unfortunate 
citizens  who  have  been  deprived  of  the  use  of  their  reason  this 
State  has  taken  an  advanced  step,  and  any  one  who  may  visit  the 
State  Hospital  at  Farnhurst  cannot  but  feel  that  we  in  Delaware 
are  among  the  most  advanced  of  civilized  communities  in  our 
care  of  these  unfortunate  people.  When  the  new  building  for  the 
tuberculosis  cases  of  this  hospital,  now  about  to  be  contracted  for, 
has  been  completed,  we  will  be  among  the  very  first  in  the  world 
to  carry  out  this  great  reform.  The  insane  and  all  defectives  are 
very  obnoxious  tO'  the  tubercle  bacillus,  and  it  is  surely  within  our 
province  and  duty  to  protect  these  poor  creatures  and  at  the  same 
time  help  stamp  out  a  horror  and  menace  to  all  the  world. 

At  the  present  time  the  condition  of  the  consumptive  is  most 
deplorable,  and  every  day  it  is  becoming  more  pitiable.  Since  the 
infectious  nature  of  the  disease  has  become  known,  his  home,  if  he 
is  among  friends,  is  his  only  refuge,  and  here  in  many  cases  he  is 
only  tolerated.  He  is  an  unwelcome  visitor  in  social  life;  he  is 
not  wanted  in  hotels  or  in  vehicles  of  travel,  and  the  wards  of  the 
general  hospitals  are  becoming  more  and  more  shut  against  him. 
Who  is  more  to  be  pitied  than  the  consumptive;  who  is  so  much 
to  be  pitied  as  he  or  she  who  has  consumption  and  at  the  same 
time  is  without  money  and  without  friends?  It  may  well  be  said 
that  the  hand  of  every  man  is  against  them,  and  may  God  help 
the  man  who  will  not  do  all  in  his  power  to  alleviate  their  helpless 
condition.  Help  is  at  hand,  and  I  trust  the  good  people  of  Dela- 
ware, both  those  in  her  legislature  and  those  who  have  means  be- 
yond their  own  necessities,  will  open  their  hearts  and  their  purses 
to  these  unfortunate  people.     Consumption  is  as  much  a  social  as 


it  is  an  individual  affliction,  and  it  behooves  the  State  to  act  for 
its  suppression  as  a  menace  to  human  happiness  and  human  ex- 
istence. Consumption  is  an  infectious  disease,  and  is  undoubtedly 
communicable  from  one  human  being  to  another,  and  notwith- 
standing the  unfortunate  break  of  the  great  Koch,  I  believe  every- 
thing points  to  the  communicability  to  man  of  the  disease  from 
the  lower  animals. 

How  far  have  we  progressed  in  the  treatment  of  consump- 
tion as  to  its  cure?  Well,  thus  far,  consumption  is  undoubtedly  a 
curable  disease.  Oh,  what  hope,  what  joy  this  conveys  to  the 
sufiferer,  when  heretofore  all  before  him  had  been  a  cloud  of  de- 
spair, as  impenetrable  as  a  rock  and  as  black  as  Erebus.  If  a  pa- 
tient with  consumption  comes  to  a  physician  now  there  is  a  very 
strong  probability  that  the  physician  may  to-day  tell  him  with 
truth  that  he  has  a  good  chance  to  get  well.  What  would  be  the 
methods  the  good  physician  would  use,  would  it  be  potions  and 
pills?  No.  Thank  God  the  science  of  medicine  is  fast  getting 
away  from  potions  and  pills.  He  would  tell  the  patient  to  go  to 
the  Sanatorium  and  get  well.  Even  ten  years  ago  he  would  prob- 
ably have  told  him  to  go  home,  his  end  from  consumption  would 
be  the  usual  end  of  all  such  sad  cases,  and  be  a  mere  question  of 
time. 

From  the  statistics  of  the  State  Board  of  Health  there  were 
in  1891  nineteen  hundred  and  fifty-one  deaths  in  Delaware.  Of 
these,  ninety-four  were  reported  as  from  consumption,  seventy- 
four  from  tuberculosis,  and  fifty-seven  from  phthisis,  making  in 
all  two  ihundred  and  twenty-five  deaths  from  tuberculosis.  Un- 
doubtedly nearly  all  of  these  deaths  were  from  pulmonary  tuber- 
culosis, or  consumption,  and  show  more  than  one  death  in  eight 
from  tuberculous  troubles.  In  1900  the  population  of  Delaware 
was:  New  Castle  county,  109.697;  Kent  county,  32.762.  and  Sus- 
sex county,  42.276.  making  the  total  population  of  the  State  184.- 
735.  In  1892  with  a  population  of  61.431  Wilmington  city  re- 
ported 127  deaths  from  tuberculosis.  In  1892  New  Castle  county 
reported  160  deaths.  Here  is  the  bad  showing  for  the  congested 
centre  and  in  these  congested  centres  our  fight  must  be  waged  the 
hardest.  In  1882  there  were  253  deaths  reported  from  consump- 
tion. In  1889  there  were  237  deaths  reported.  In  1890  there  were 
239  deaths  reported.  In  i8gi  there  were  319  deaths  reported 
from  consumption,  being  164  in  New  Castle  county,  61  in  Kent 
county,  and  94  in  Sussex  county.  I  quote  these  statistics  to  show 
the  necessity  of  action  on  the  part  of  our  people  to  stay  this  ter- 
irble  scourge.  I'oston  statistics  show  that  the  mortality  from 
consumption  has  decreased  six  per  cent  in  the  last  twenty  years. 


6 

This  is  encouraging.  Boston  is  away  up  head  both  in  her  sta- 
tistical methods  and  in  her  fight  against  consumption. 

What  is  the  modern  method  of  fighting  consumption?  First, 
commence  the  fight  in  the  incipient  stages  and  keep  it  up  bravely 
until  one  party  yields.  The  great  remedies  are  fresh  and  pure  air, 
sunlight,  amusement  and  employment  for  the  mind  and  body, 
water  in  its  various  forms  and  uses,  massage,  pneumatics  and 
gymnastics  and  forced  feeding.  These  combine  the  chief  weap- 
ons. Drugs  take  a  secondary  place  and  are  only  used  on  certain 
occasions  and  under  special  conditions.  Serum  treatment  for 
tuberculosis  is  not  yet  encouraging.  Inject  Koch's  tuberculin, 
which  is  a  toxin  and  not  an  antitoxin,  into  a  consumptive,  and 
you  get  a  rise  of  temperature  and  confirm  the  diagnosis  and  you 
do  the  patient  no  injury  whatever.  Continue  this  injection  and 
this  toxin  you  inject  is  aided  by  the  toxin  of  secondary  infection 
already  in  the  consumptive's  blood  and  you  do  him  harm.  This 
is  why  Koch's  tuberculin  failed  and  we  witnessed  the  solemn 
spectacle  of  disappointment  among  consumptives  and  their 
friends.  The  bacillus  itself  is  a  parasite  and  lives  on  the  animal 
body.  The  problem  before  us  is  to  destroy  it  and  its  toxin  de- 
veloped by  it  in  the  animal  body  and  yet  not  destroy  that  animal 
body.  The  successful  serum  will  not  be  a  toxin  serum  as  are  the 
tuberculins,  but  an  antitoxin  serum  like  diphtheria  antitoxin. 
Some  animal  will  be  rendered  immune  to  the  toxin  and  its  serum 
will  be  the  antitoxin  to  the  tubercle  bacillus  toxin  and  also  if  to 
the  bacillus  itself,  then  we  will  have  it. 

How  and  where  are  these  remedies  best  applied?  At  home, 
in  the  Sanitarium  or  in  the  Sanatorium.  Home  treatment  is  a 
possibility  under  two  conditions.  First,  where  the  patient  has 
means  and  a  proper  home  with  proper  medical  supervision.  Sec- 
ondly, where  the  patient  has  advanced  to  the  stage  of  secondary 
infection  in  the  disease  he  may  have  to  do  the  best  he  can  at  his 
home.  There  is  a  possibility  of  one  going  to  one  of  the  numer- 
ous Sanitaria  in  the  country  and  getting  good  care  and  good  at- 
tention, but  these  institutions  no  longer  want  tuberculous  cases 
and  many  won't  take  them,  and  very  properly  so.  Next  we  come 
to  the  Sanatoria.  Here  is  the  proper  place  to  treat  the  consump- 
tive, and  if  all  incipient  cases  to-day  could  get  such  treatment  I 
have  little  doubt  but  in  twenty-five  years  the  mortality  from  con- 
sumption would  fall  ofif  fifty  per  cent.  While  the  first  great  use  of 
the  Sanatorium  is  probably  for  treatment,  it  is  of  almost  as  great 
use  as  an  educator.  Here  is  where  it  comes  in  as  a  factor  in  po- 
litical economy.  A  patient  at  a  Sanatorium  soon  learns  how  to 
care  for  himself  as  to  reinfection  of  his  own  system  and  the  infec- 
tion of  others,  and  w*hen  he  goes  home  to  his  family  he  carries  out 


these  rules,  and  even  if  not  cured  he  so  Hves  as  to  make  himself 
little  or  no  menace  to  the  lives  of  others.  Thus  in  the  end  Sana- 
toria will  save  many  lives  to  the  State,  and  each  of  these  lives  ih 
worth  $5,000.  There  comes  in  the  economical  factor.  It  is  the 
cold-blooded  way  to  look  at  it,  but  it  is  nevertheless  true.  The 
State  gets  back  in  dollars  and  cents  more,  much  more,  than  she 
expends  in  thus  protecting  her  citizens. 

My  chief  object  in  writing  this  article,  I  may  say,  after  bring- 
ing the  matter  of  the  modern  treatment  of  consumption  before 
the  people  of  Delaware,  is  to  call  the  attention  of  the  coming 
Legislature  to  not  only  the  advisability,  but  to  the  necessity  of 
providing  a  State  Sanatorium  for  Consumptives  for  the  use  of  the 
citizens  of  the  State,  and  I  trust  the  medical  profession,  the  State 
Board  of  Health  and  the  different  local  Boards  of  Health  and  all 
the  good  people  of  Delaware  will  second  this  appeal  with  all  the 
strength  and  all  the  force  they  can  command.  I  can  only  imagine, 
I  can  only  hear  one  objection, — money.  It  is  not  a  matter  of  dol- 
lars and  cents,  it  is  a  matter  of  absolute  necessity  to  relieve  the 
horrors  of  a  situation  no  one  has  yet  stopped  to  consider,  a  situa- 
tion, if  not  taken  in  hand,  is  sooner  or  later  destined  to  undermine 
the  human  race  and  make  defectives  and  pigmies  of  us  all.  IMassa- 
chu setts,  probably  the  most  democratic  in  her  State  government 
of  all  the  States,  I  mean  by  that,  that  her  people  are  more  largely 
represented  in  her  State  Senate  and  House  than  are  the  people  of 
any  other  State,  has  taken  the  lead  in  this  matter,  as  she  does  in 
all  matters  pertaining  to  the  good  of  her  citizens,  and  has  estab- 
lished at  Rutland,  Massachusetts,  a  Sanatorium  for  the  treatment 
of  consumption,  with  a  capacity  of  two  hundred  and  fifty  patients. 
Our  neighbor.  New  Jersey,  has  through  her  last  Legislature, 
made  a  large  appropriation  and  the  site  for  the  building  has  just 
been  chosen  on  the  high  ground  of  upper  Jersey.  Ohio  has  also 
moved  in  the  matter,  and  she  too  will  soon  have  her  State  Sana- 
torium for  Consumptives,  as  surely  every  State  in  the  Union 
must,  sooner  or  later.  Those  who  lag  must  bear  the  burden. 
Since  my  last  writings  on  this  subject  in  the  latter  part  of  1899 
the  knowledge  of  treatment  has,  of  course,  made  some  advances, 
rapid  advances  indeed.  To-day  the  high  elevation  is  not  con- 
sidered of  such  great  importance.  Open  air.  sunlight  and  feeding 
are  of  the  greatest  importance.  Cases  do  well  with  these  remedies 
properly  applied  even  if  near  the  sea  level.  Put  the  Sanatorium 
in  the  most  available  place  your  State  affords,  treat  the  patient  in 
his  own  natural  environment  so  that  when  he  gets  well  lie  makes 
no  radical  change  in  his  surroundings.  These  are  probably  the 
latest  and  best  ideas.  Another  point.  Will  the  establishment  of  a 
Sanatorium  in  a  community  raise  a  local  panic  of  fear  of  infection 


of  the  neighborhood?  On  first  thought  such  might  be  the  effect, 
but  experience  of  the  Sanatoria  in  Germany  where  they  have  been 
estabHshed  for  fifty  years,  and  of  all  the  Sanatoria  that  have  been 
established  in  England  and  in  the  United  States,  in  fact  all  every- 
where, teach  just  the  opposite.  In  all  neighborhoods  where  con- 
sumptives congregate  in  Sanatoria,  or  in  towns  and  villages 
where  they  congregate  for  private  treatment,  the  mortality  from 
consumption  among  the  old  residents  has  visibly  declined  and  the 
general  death  rate  has  declined.  The  reason  is  this:  The  com- 
munity has  been  educated  as  to  how  to  treat  the  consumptive  and 
how  to  avoid  infection  from  resident  consumptives.  A  higher 
civilization  has  dethroned  the  sign  "don't  spit  on  the  floor,"  as 
useless,  just  as  in  the  far  West,  the  same  hig'her  civilization  has 
dethroned  the  sign  of  the  red  lantern  saloons,  "don't  shoot  the 
musician,  please,  he  is  doing  all  he  knows."  Any  community 
may  welcome  a  Sanatorium  for  consumptives  as  an  educator  and 
purifier  and  in  many  ways  desirable. 

I  have  spoken  of  the  Massachusetts  State  Sanatorium  for 
Consumptives  at  Rutland.  This  institution  is  known  officially  as  the 
Rutland  Sanatorium.  The  word  consumptive  in  connection  with  it 
is  referred  to  as  little  as  possible.  This  is  in  keeping  with  the  gen- 
eral idea  prevailing  to-day.  The  Delaware  State  Hospital  for  the 
Insane  is  known  now  as  the  Delaware  State  Hospital  atFarnhurst. 
It  is  not  known  bv  its  designation  as  an  insane  asylum.  I  recently 
visited  Rutland  with  a  letter  from  Dr.  Osier  to  Dr.  Walter  J. 
IMarcley  the  efficient  superintendent.  I  spent  a  pleasant  and 
profitable  day  there  and  was  shown  marked  attention  by  Dr.  Mar- 
cley  and  his  assistants.  Doctors  Dunham  and  Lapham.  The  in- 
stitution at  present  accommodates  250  patients,  about  equally  di- 
vided between  male  and  female.  Most  of  them  appear  to  be  be- 
tween twenty  and  thirty  years  of  age.  I  noticed  one  case,  a  fe- 
male, 57  years  of  age.  The  elevation  here  is  about  1200  feet  and 
the  buildings  are  so  placed  on  the  southern  declivity  as  to  leave 
a  well  wooded  hill  behind  them  which  serves  to  keep  off  the 
northern  storms.  The  proper  railroad  station  is  ^luschopauge, 
one  station  nearer  Worcester  than  Rutland,  and  where  a  good 
conveyance  is  usually  found  to  convey  persons  to  the  Sanatorium. 
The  State  owns  about  250  acres  of  land  and  is  about  erecting 
farm  buildings.  This  land  cost  about  $5,500.  The  structures  are 
frame,  with  of  course,  much  glass.  Outside  is  frame  with  metal 
laths  and  over  this  slap  dash  cement  finisih.  Inside  are  metal 
laths,  hard  plaster  and  enamel  paint.  This  gives  a  hollow  and  en- 
tirely dry  wall.  The  Hospital  was  opened  in  the  fall  of  1898.  The 
act  creating  it  was  passed  in  1895.  Recently  a  new^  addition  has 
been  added.    The  State  has  already  spent  on  this  institution  near- 


9 

ly  a  half  million  of  dollars.  There  are  a  series  of  two-story  build- 
ings built  in  a  semi-circle  with  the  administration  building  in  the 
centre.  There  are  two  kinds  of  pavilions.  One  kind  has  seven 
small  rooms  and  a  large  ward  accommodating  twenty-two  pa- 
tients. The  other  kind  of  pavilion  has  seven  rooms  and  a  ward 
accommodating  only  ten  patients.  Each  pavilion  has  a  glass  so- 
larium or  sun  parlor  and  large  verandas  encircle  all  the  buildings. 
In  the  pavilions  the  sexes  are  separated  by  the  administration 
building.  The  idea  at  the  start  at  this  Sanatorium  was  to  receive 
only  incipient  cases,  and  not  make  it  in  any  way  a  home  for  the 
hopelessly  sick.  Patients  who  do  not  improve  after  a  sufBcient 
trial  are  advised  to  leave  and  take  treatment  elsewhere  more 
adapted  to  their  cases.  I  may  say  while  passing,  many  private 
Sanatoria  are  being  started  in  many  parts  of  the  country  and  those 
who  have  means  will  be  amply  provided  for  in  all  stages  of  the 
disease.     But  the  poor,  where  is  their  refuge? 

An  incipient  case  is  one  where  the  physical  signs  are  confined 
to  small  areas  in  one  or  both  apecis  and  where  the  3  p.  m.  tem- 
perature is  not  marked.  All  patients  take  their  own  temperature 
on  rising  in  the  morning  and  at  3  p.  m.  the  temperature  of  every 
patient  is  very  carefully  taken  by  a  trained  nurse  and  noted  on  the 
card.  This  is  the  temperature  that  tells  the  story.  After  the  in- 
cipient comes  the  well  "marked  incipient  cases."  Here  the  phy- 
sical signs  are  a  little  more  marked.  A  moderately  advanced  case 
is  one  when  we  have  dullness,  mucous  and  bubbling  rales  and 
bronchial  breathing.  The  advanced  cases  have  the  well  marked 
cavities,  with  secondary  infection,  with  all  that  this  implies.  Dr. 
Vincent  Y.  Howditch  of  Boston,  one  of  the  visiting  physicians, 
says,  that  although  the  Hospital  is  primarily  for  incipient  cases,  a 
large  number  in  whom  the  disease  was  well  marked  and  even  ad- 
vanced have  been  received  when  there  was  a  prospect  of  improve- 
ment. The  results  in  the  latter  he  says  have  often  been  most  sur- 
prising and  gratifying.  No  patient  can  take  a  private  room  and 
thus  there  arc  no  privileges  that  money  can  buy  that  give  one  pa- 
tient favors  over  another  patient.  The  private  rooms  are  under  the 
care  of  the  physicians  ancl  a  patient  is  put  in  one  of  these  rooms 
for  cause.  They  are  isolation  rooms  as  it  were,  and  are  used  for 
acute  illness,  etc.  Most  of  the  professions  are  represented  among 
the  inmates.  Many  are  school  teachers  and  many  tradesmen  and 
tradeswomen  and  many  laborers.  No  distinction  whatever  is 
made.  It  is  altogether  a  democratic  institution.  From  October 
I,  1900,  to  October  i,  190 1.  Dr.  Bowditch  rc])orte(l  201  cases  con- 
sidered. Men.  102;  women,  99.  Average  age.  28  years.  Average 
length  of  stay  in  institution,  six  months.  Eighty-five  left  with  tlie 
disease  arrested.    .\n  arrested  case  is  where  the  cough,  expectora- 


10 

tion,  bacilli  and  fever  have  disappeared  and  where  the  patient 
looks  healthy.  If  this  arrested  condition  continues  two  years  the 
case  is  pronounced  cured.  Only  eight  cases  left  not  improved. 
There  were  no  deaths.  Eighty-five  cases  were  arrested,  forty-five 
very  much  improved,  thirty-one  much  improved,  improved, 
thirty-two.  Of  the  arrested  cases,  the  longest  stay  was  14  months 
7  days.  The  average  stay  of  these  cases  was  5  months  and  12 
days.  The  shortest  stay  was  one  month  and  8  days.  Of  the  very 
much  improved  cases  the  longest  stay  was  22  months  and  22 
days.  Of  the  much  improved  cases  the  longest  stay  was  16 
months.  Average  gain  in  weight  of  all  cases  was  14.2  pounds. 
Greatest  gain  in  weight  of  arrested  cases  was  36  pounds.  Every 
year  more  favorable  results  are  obtained  in  all  cases.  Of  35  cases 
tabulated  as  arrested  in  1898-1899  all  are  alive  except  two.  Of 
33  remaining  26  are  known  to  be  well  and  are  at  work.  Dr.  Bow- 
ditch  has  recently  examined  many  of  these.  It  may  be  stated  here 
that  circulars  of  inquiry  are  constantly  sent  to  the  discharged 
cases  and  replies  are  received  regularly,  thus  keeping  the  run  of 
the  cases. 

Seven  cases  discharged  as  improved  in  1898-1899  are  still  in 
good  shape.  Of  56  cases  arrested  and  discharged  in  1899-1900 
all  are  in  good  shape  except  4,  relapsed.  These  are  wonderful  re- 
sults and  most  encouraging. 

During  my  visit  I  dined  with  Dr.  Marcley  and  his  family, 
composed  of  his  mother.  Doctors  Dunham  and  Lapham  and 
about  two  hundred  and  fifty  consumptives.  I  hope  I  will  not  ex- 
ceed the  bounds  of  social  etiquette  if  I  tell  what  we  had  for  din- 
ner. First,  every  one  appeared  to  have  a  good  appetite  and  did 
ample  justice  to  a  good  soup,  roast  beef,  potatoes,  beets,  bread 
and  butter  and  milk,  followed  by  a  cornstarch  pudding.  Here  we 
had  nitrogen  carbohydrates  and  fats  in  a  well  adjusted  ration. 
Every  one  was  cheery  and  there  was  little  or  no  coughing.  The 
day  was  frosty  and  just  before  dinner  the  temperature  of  the  room 
was  run  up  to  60  degrees  Fah.  and  again  opened  up  after  dinner. 
The  patients  get  up  at  7  a.  m.,  take  a  cold  bath  and  breakfast  at 
7.30;  luncheon,  10.30;  dinner  at  12;  luncheon,  3.30;  supper,  6: 
luncheon,  8.30;  lights  out  at  9.30.  If  cold  in  the  morning  the 
watchman  shuts  doors  and  windows  of  rooms  and  wards  at  6  a. 
m.  and  runs  temperature  up  to  60  degrees  Fah.  to  dress  by.  When 
this  is  over  they  are  immediately  opened  up  again.  All  windows 
and  doors  of  rooms  and  wards  are  open  when  patients  are  in  bed, 
even  if  the  thermometer  goes  below  zero.  If  cold,  use  more 
clothes  and  coverings.  No  carpets  or  hangings  allowed.  When 
not  in  bed  patients  are  out  on  the  grounds  or  piazzas  or  in  the 
sun  parlors.    Rules  as  to  expectorating  are  absolute.    Always  ex- 


11 

pectorate  in  the  pocket  flask  or  in  cuspidors  in  the  house  appoint- 
ed for  the  purpose.  Never  even  expectorate  on  the  ground  in  the 
woods  on  pain  of  dismissal,  and  never  swallow  expectoration, 
never.  Through  the  woods  are  many  huts  and  tents  open  to  the 
south  where  patients  spend  much  time,  and  some  are  even  pro- 
vided with  improvised  stoves  where  they  may  toast  their  feet. 
There  is  a  large  and  well  appointed  amusement  room  seating  sev- 
eral hundred  attached  to  the  Sanatorium  and  there  are  many  very 
bright  people  among  the  patients.  They  give  entertainments  and 
many  outsiders  come  to  them.  One  may  ask,  are  they  not  afraid 
of  taking  the  disease?  No.  Tubercle  bacilli  have  no  show  in  this 
institution.  They  never  get  loose  and  there  is  no  infection  of 
other  people.  It  is  far  safer  for  a  healthy  stranger  in  the  theatre 
of  the  Rutland  Sanatorium  with  a  crowded  audience  than  it  is  for 
him  in  any  average  place  of  amusement,  or  hotel  dining  room  in 
any  part  of  the  world.  After  ten  years  education  by  Sanatoria 
and  such,  these  average  places  of  amusement  and  hotel  dining 
rooms  will  be  much  safer  than  they  are  now.  Here  is  one  of  the 
great  reasons  for  the  States  imitating  Massachusetts  in  starting 
Sanatoria  for  consumptives.  October,  1900,  to  October,  1901, 
the  cost  per  patient  per  week  was  in  all  $9.47.  The  patients  each 
pay  $4  per  week  and  the  State  pays  the  remainder,  being  that 
year  $5.47  per  week.  Many  of  the  patients  work  out  their  board 
and  there  will  be  more  of  these  when  the  farm  buildings  have 
been  finished.  There  are  six  trained  nurses  employed  at  $30  per 
month.  As  a  rule,  with  their  life  in  the  open  air  night  and  day, 
patients  never  get  a  cold.  Here  is  an  object  lesson  for  us.  The 
poor  consumptive  always  tells  us  how  he  took  his  cold.  He  is  in 
error.  He  has  not  taken  cold  out  of  doors.  Tubercle  bacilli  get 
in  their  work  in  the  house  and  in  crowded  rooms.  There  are 
colds.  We  take  them  from  going  from  hot  to  cold,  from  dry 
to  wet.  A  part  becomes  chilled,  here  is  a  local  congestion,  be  it 
in  the  lungs  or  some  other  place,  here  is  a  focus  of  infection,  the 
pathogenic  germ  does  his  work  here  and  the  kind  of  germ  domi- 
nates the  coming  illness.  This  is  taking  cold.  I  visited  the  model 
dairy  farm  owned  by  a  gentleman  from  Hartford.  Here  were 
stabled  sixty  Holstein  and  Guernsey  cows,  as  fine  as  I  ever  saw. 
and  the  surroundings  were  perfect  for  such  an  establishment. 
Each  cow  is  tested  by  tuberculin  every  six  months  and  any  sus- 
picious cow  is  at  once  eliminated.  From  this  dairy  about  400 
quarts  of  milk  go  to  the  Sanatorium  daily.  Tuberculin  is  some- 
times used  in  the  institution  as  a  diagnostic  test  on  patients  with 
satisfactory  results.  An  an  illustration  of  how  the  patients  are 
fed.  Dr.  Marcley  told  me  some  individuals  took  as  much  as  24 
glasses  of  milk  in  24  hours.     This     amounts     probably     to  five 


12 

quarts.  Many  take  six  raw  eggs  and  would  take  more,  but  the 
supply  is  limited.  Of  course  cases  with  poor  digestion,  with  a 
tendency  to  diarrhoea  and  similar  troubles  showingthe  mesentery, 
intestinal  tract,  and  such  parts  involved,  do  not  do  well.  The  cure 
of  consumptives  showing  these  sysptoms  is  usually  hopeless. 


13 


A  Delaware  State  Sanatorium  for  Consumptives. 


There  are  probably  at  the  present  time  in  Delaware  5,000 
persons  suffering  from  tuberculosis  in  its  graver  or  lesser  forms. 
Dr.  Vincent  Y.  Bowditch  says  there  are  probably  200,000  cases  of 
consumption  in  ^Massachusetts  to-day.  Massachusetts  has  a  pop- 
ulation of  nearly  3,000,000.  The  same  population  would  give 
Delaware  over  12,000  cases,  but  as  Massachusetts  is  full  of  con- 
gested centres  of  population  I  should  say  5,000  might  cover  the 
number  of  cases  of  tuberculosis  of  all  grades  in  Delaware.  Some 
authorities  say  tuberculosis  is  some  form  attacks  fully  one-third 
of  all  the  people  in  overpopulated  countries.  What  an  object  les- 
son to  spur  us  on  to  active  work  for  the  preservation  of  the  race. 

It  is  neither  practical  nor  desirable  that  all  of  these  people 
should  go  to  a  State  Sanatorium.  The  Sanatorium  should  be 
started  to  aid  as  many  as  possible  of  the  cases  fit  for  hospital 
treatment,  and  especially  should  it  be  started  to  commence  to 
educate  not  only  the  sick  but  the  general  public  as  to  the  possi- 
bility and  feasibility  of  the  cure  of  consumption  to  prevent  its 
communication  to  healthy  persons.  Here  are  the  uses  of  the 
Sanatorium  for  Consumptives  and  sooner  or  later  every  State 
must  take  this  matter  up  and  act  favorably,  liberally  and  intelli- 
gently upon  it.  Why  should  Delaware  delay?  Why  should  her 
people  falter  in  a  matter  so  vital  to  the  preservation  of  the  race 
and  to  their  temporal  prosperity?  Let  Delaware  become  an  ad- 
vanced State  in  all  matters  pertaining  to  the  prosperity  of  her  in- 
habitants, and  see  how  soon  intelligent  people  from  other  com- 
munities will  seek  homes  within  her  borders  and  thus  pay  many 
fold  for  all  money  expended  in  such  laudable  progress.  To  make 
a  beginning  in  this  great  work  I  believe  the  State  should  accjuire 
the  proper  amotmt  of  land  and  put  up  proper  buildings  to  ac- 
commodate thirty  patients.  Tt  would  be  possible  to  increase  this 
number  for  at  least  eight  months  in  the  year  l)y  forming  a  camp 
of  tents  and  huts  on  the  grounds  of  the  Sanatorium  proper.  Thus 
great  good  would  be  done  and  the  campers  would  be  so  educa- 
ted as  not  to  be  a  menace  to  themselves  and  others  when  they  re- 
turn to  their  homes.  See  the  possibility  here.  This  education 
commencing  and  going  on  constantly  must  in  a  very  few  years 


14 

go  far  to  stamp  out  this  horrible  affliction,  and  oh  the  hope  it 
brings  to  those  Hves  we  prize  so  dearly  when  overtaken  by  this 
Great  White  Plague.  Don't  go  home  to  die,  go  to  the  Sanator- 
ium and  get  well.  God  hasten  the  day  when  every  physician  in 
Delaware  can  thus  lift  the  great  load  from  his  own  conscience 
and  gladden  the  hearts  of  his  consumptive  patients.  Is  there  any 
point  to-day  which  comes  up  to  the  well  versed  physician  and 
vexes  more  in  its  solution  that  what  to  do  with  our  consumptive 
patients?  We  know  what  we  ought  to  do,  but  we  are  helpless 
and  the  poor  patients  are  helpless  and  a  menace  to  themselves 
and  others. 

As  to  the  location  of  the  Sanatorium  the  southern  slope  of 
Iron  Hill  would  be  an  ideal  site.  It  is  among  the  highest  points 
in  the  State,  about  340  feet  above  tide  water,  and  in  every  way 
desirable.  It  should  be  possible  to  acquire  land  there,  say  one 
hundred  to  two  hundred  acres,  at  a  reasonable  rate  and  placing 
the  buildings  at  a  reasonable  distance  from  the  top,  well  wooded, 
would  give  a  windbreak  sufficient  to  make  the  surroundings  all  to 
be  wished  for  in  a  Sanatorium.  The  location  of  the  institution, 
wherever  it  may  be,  will  in  every  way  add  tO'  the  importance,  the 
development  and  the  material  advance  of  the  neighborhood.  The 
cost  of  buildings  should  not  be  great.  Four  hundred  dollars  per 
patient  for  thirty  patients  would  be  a  fair  estimate.  To  provide 
for  something  extra  for  the  administration  building,  I  should 
think  $15,000  would  be  sufficient  to  start  the  enterprise  so  far  as 
the  buildings  are  concerned.  Exclusive  of  salaries  and  some 
other  items,  I  believe  one  dollar  per  day  per  patient  should  cover 
the  expenses  of  the  institution.  For  thirty  patients  this  would 
amount  to  say  $11,000  per  year.  Let  the  patients  pay  50  cents 
per  day  board.  This  should  cover  salaries  and  the  other  items. 
One  physician  and  two  trained  nurses  should  be  able  to  carry  on 
the  work  at  the  start.  The  patients  need  very  little  nursing. 
Much  of  the  other  help  can  be  obtained  by  persons  willing  to 
work  for  their  board  and  treatment.  These  estimates  I  know  are 
shaved  very  close,  but  if  the  State  will  purchase  the  site  and  ap- 
propriate $25,000  the  first  year  I  believe  the  buildings  can  be  built 
and  the  undertaking  be  fairly  launched  to  run  to  January  i,  1904. 
An  appropriation  of  $12,000  more  would  carry  it  up  to  the  time 
of  the  next  Legislature,  January,  1905.  Now  let  the  Legislature 
act  and  their  names  will  go  down  in  the  history  of  Delaware  as 
the  creators  of  the  grandest  work  of  the  century!  I  repeat,  this  is 
not  a  question  of  dollars  and  cents,  it  is  a  question  of  happy 
homes,  of  lives  plucked  from  fires  fed  by  the  parasites  around  us, 
a  question  of  very  salvation  to  the  human  race. 


■a 


15 

The  State  Board  of  Health  of  Delaware  is  composed  of  gen- 
tlemen taken  from  among  our  best  and  ablest  citizens,  and  I  be- 
lieve the  Legislature,  if  in  its  wisdom  it  should  see  fit  to  enact  a 
law  establishing  this  great  charity,  would  in  every  way  do  the 
right  and  proper  thing  did  it  enthrone  them  with  the  power  to 
erect  and  carry  on  a  Sanatorium  for  the  treatment  of  unfortunate 
citizens  of  this  State  suffering  from  consumption.  Let  us  have  a 
Delaware  Sanatorium,  or  an  Iron  Hill  Sanatorium,  or  a  Sanator- 
ium by  any  other  name,  so  the  word  consumption  has  no  share  in 
it.  Then  we  can  say  to  the  wayfarer  who  hitherto  has  only  been 
treading  the  downward  path,  don't  go  home  to  die,  take  hope,  go 
to  the  Sanatorium  and  get  well.    God  speed  the  day. 

Note. — For  an  object  lesson  as  to  what  can  be  accomplished  by  the 
establishment  of  a  Sanatorium  for  Consumptives,  see  an  illustrated  article 
in  the  Philadelphia  Medical  Journal,  November  8.  1902,  by  Dr.  Lawrence 
F.  Flick,  entitled,  "A  Year's  Work  at  the  White  Haven,  Pa.,  Sanatorium 
of  the  Free  Hospital  for  Poor  Consumptives." 


SUNDAY    STAH    PRINT. 
Wilmington.    Delaware 


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